丹参酮ⅡA磺酸钠注射液对急性心肌梗死患者心肌酶学及心脏泵血功能的影响

目的 探讨丹参酮ⅡA磺酸钠注射液对急性心肌梗死(acute myocardial infarction,AMI)患者心肌酶学及心脏泵血功能的影响.方法 将符合入选标准的217例AMI患者按随机数字表法分为对照组110例和丹参酮组107例.对照组采用溶栓、扩管、降压及抗休克等常规急救处理;丹参酮组在对照组基础上静滴丹参酮ⅡA磺酸钠注射液.采用ELISA法检测血清CKMB、SOD、MDA和心肌肌钙蛋白I(cardiac troponin,CTNI)水平;采用直接测压法测量患者收缩压、舒张压并计算脉压,监测心率;采用心腔四切面彩色多普勒超声心动图仪监测左室最大上升/下降速率(±LVdp/dtmax)、左心室舒张末期内径(left ventricular end diastolic diameter,LVDD)、左心室射血分数(left ventricular ejection fraction,LVEF),评价临床疗效.结果 丹参酮组总有效率为98.1%(105/107)、对照组为87.2%(96/110),2组比较差异有统计学意义(χ2=10.417,P<0.05).治疗后,CKMB[(10.76±1.02)mmol/L比(15.17±1.21)mmol/L,t=5.035]、CTNI[(0.11±0.02)ng/mL比(1.51±0.05)ng/ml,t=3.724]、MDA[(4.54±0.23)nmoL/mL比(9.98±1.37)nmoL/ml,t=2.570]低于对照组(P<0.05),SOD[(452.27±21.56)U/L比(209.50±15.43)U/L,t=3.935]高于对照组(P<0.05);LVDD[(50.74±5.36)mm比(44.91±5.31)mm,t=4.925]和LVEF[(4.59±0.17)%比(3.64±0.11)%,t=4.052]高于对照组(P<0.01),但反映心脏泵功能的+LVdp/dtmax[(3742±162)mmHg/s比(3948±193)mmHg/s,t=3.731]、-LVdp/dtmax[(3512±135)mmHg/s比(3847±181)mmHg/s,t=3.025]、脉压[(30.5±5.3)mmHg比(35.8±5.1)mmHg,t=2.902]、舒张压[(99.2±8.8)mmHg比(117.3±10.8)mmHg,t=4.079]等均低于对照组(P<0.05).结论 在西医常规治疗基础上静脉滴注丹参酮ⅡA磺酸钠注射液可明显改善AMI患者心肌酶学指标,提高心脏泵血功能,可保护因急性心肌缺血造成的AMI.

Effects of Tanshinone on myocardial enzymes and heart function of acute myocardial infarction

Objective To investigate the effects of sodium tanshinone ⅡA injection on myocardial enzymes and heart function of patients with acute myocardial infarction, and to explore its therapeutic mechanism. Methods A total of 217 patients with acute myocardial infarction in Taihe Hospital emergency department were randomly divided into control group (n=110) and the Tanshinone group (n=107). The control group was treated by thrombolysis, vascular dilation, antihypertension, anti-shock and other conventional treatment. On the basis of control group treatment, Tanshinone group added the intravenous injection 20mg sodium tanshinone injection. The ELISA was used to test serum creatine kinase (CKMB), superoxide dismutase (SOD), malondialdehyde (MDA) and cardiac troponin I (CTNI) and other enzymes indexes before and after treatment. The heart function were assessed by measuring the left ventricular patient of maximum rising/ falling rate (± LVdp/dtmax),left ventricular end-diastolic diameter (LVDD), left ventricular ejection fraction (LVEF),systolic blood pressure (SP), diastolic blood pressure (DP), pulse pressure (PP ) and heart rate (HR) and other indicators. Results After treatment, the CK-MB (10.76 ± 1.02 mmol/L vs. 15.17 ± 1.21 mmol/L, t=3.724), CTNI (0.11 ± 0.02 ng/ml vs.1.51 ± 0.05 ng/ml, t=2.570), MDA (4.54 ± 0.23 nmol/ml vs. 9.98 ± 1.37 nmol/ml, t=5.035) in the Tanshinone group were significantly lower than those in the control group (P<0.05). The SOD (452.27 ± 21.56 U/L vs. 209.50 ± 15.43 U/L, t=3.935), LVDD (50.74 ± 5.36 mm vs. 44.91 ± 5.31 mm, t=2.454) and LVEF (4.59% ± 0.17% vs. 3.64% ± 0.11%, t=4.052) in the Tanshinone group were significantly higher than those in the control group (P<0.05). The heart function of +dp/dtmax (3742 ± 162 mmHg/s vs. 3948 ± 193 mmHg/s, t=3.731), -dp/dtmax (3512 ± 135 vs. 3847 ± 181, t=3.025), PP (30.5 ± 5.3 mmHg vs. 35.8 ± 5.1 mmHg, t=2.902), DP (99.2 ± 8.8 mmHg vs. 117.3 ± 10.8 mmHg, t=4.079) in the Tanshinone group were significantly lower than those in the control group (P<0.05). The total effective rate was 98.14% (105/107), the control group was 87.2%(96/110), and there was significant difference between the 2 groups (χ2=10.417, P<0.05). Conclusions The Tanshinone ⅡA sodium injection can improve myocardial enzymes and heart function of patients with acute myocardial infarction, which refered to its protective effect on acute myocardial infarction.